A 35-year-old female presents requesting evaluation for ADHD. She reports lifelong difficulty with organization, frequently losing important items, difficulty completing tasks at work, and chronic procrastination. She also reports significant anxiety with worry about work performance, restlessness, difficulty concentrating, and irritability for the past 2 years. She states the anxiety has worsened since her recent promotion. She recalls being told by elementary school teachers that she "daydreamed too much" and frequently received report card comments about not meeting her potential. Her GAD-7 score is 14 and her Adult ADHD Self-Report Scale (ASRS) screening is positive. She has no history of substance use, trauma, or prior psychiatric treatment. Which of the following is the MOST important diagnostic consideration?